The Burden of Disorders of the Brain

It appears that more than a third of people in Europe (164.8 million persons) suffer from mental disorders and only a quarter of these receive help. Wittchen and collaborators (Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany) report 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union. The burden of mental disorders appears to have increased since 2005 but this is largely due to the inclusion of new disorders and also the inclusion of childhood/adolescence as well as the elderly. The most frequent disorders are anxiety disorders, insomnia, major depression, alcohol and drug dependence, ADHD in the young, and dementia. There is no indication of improved care which is still inadequate and subject to delays. The four most disabling single conditions were depression, dementias, alcohol use disorders, and stroke. The estimated number of people affected by major depression in the 30 countries studied is 30 million — the single greatest burden of all human diseases.

However, should all the disorders included be labeled mental disorders, are they necessarily brain disorders, and should they all be classified as diseases that urgently require treatment? The definition of mental disorder has varied widely in the past – some mental disorders, e.g., hysteria, have disappeared – new disorders constantly appear, e.g., social phobia and post traumatic stress. For some disorders, there are many contributing factors that may place them outside of the definition of brain disease. In other cases, defective brain processes are clearly responsible, as in Alzheimer’s disease. Sometimes mental anguish is temporary – it is not clear in all cases that labeling and clinical treatment with possible over-emphasis on drug treatment are required.